Provider Demographics
NPI:1316715725
Name:BEARD, DALLIN RICHARD
Entity type:Individual
Prefix:
First Name:DALLIN
Middle Name:RICHARD
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LILAC ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1738
Mailing Address - Country:US
Mailing Address - Phone:435-744-3535
Mailing Address - Fax:
Practice Address - Street 1:140 LILAC ST APT 4
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1738
Practice Address - Country:US
Practice Address - Phone:435-744-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician